DEVELOPMENT AND INITIAL VALIDATION OF A TOOL TO CHECK COMPETENCY OF INHALER USE IN PATIENTS WITH OBSTRUCTIVE LUNG DISEASES
Sam Johnson Udaya Chander J.*, Santhakumar S., Sam Solomon W.D., Akelesh T., Kandasamy C. S., Arulraj P. and Venkatanarayanan R.
Background: For obstructive lung diseases like COPD, delivering drugs directly to the airways through inhalers has become the primary modality of treatment. Errors during inhaler use accounts for decreased drug delivery to the lungs, leading to poor disease outcome. An impediment to assess proper inhaler technique has been lack of an accepted and validated scoring system. The objective of this study was to design, test, and validate a new scoring system to assess accuracy of inhaler use that can be used easily, is reproducible, and provides an accurate measurement system for clinical applications. Methods/Design: An expert panel of pulmonologists and clinical pharmacists were convened to design a simple, objective, and reproducible assessment tool to measure the accuracy of inhaler use. To test the validity, the developed scoring system was administered to a sample of 213 COPD patients prescribed with inhalers and scores were calculated. The construct validity and external criteria related validity was measured by correlating the checklist score with FEV1% predicted and FEV1/FVC ratio. Results: Inhaler use checklist and scoring sheet for five commonly used inhalers: pMDI, pMDI with spacer, Accuhaler, Handihaler, and Turbuhaler was developed. The mean percentage of steps correctly executed were correlated with FEV1 % predicted (r2 = -0.131, P<0.001) and FEV1/FVC ratio (r2 = -0.256, P<0.001). Conclusion: Results confirm homogeneity and validity of developed checklist and suggest usefulness of this tool in both clinical practice and research to assess the accuracy of inhaler use.[Full Text Article]